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Fagerström Test shows vaping is less addictive than nicotine gum, say scientists

To hear the anti-tobacco lobby talk about the addictive nature of nicotine-enhanced e-cigs, many might assume that vaping is just as dependence-inducing as heroin or cocaine.  After reading some of the negative propaganda being spread about online, they might also believe that vaping is just as deadly. 

However, all nicotine replacement therapies (NRTs) contain some level of nicotine, including nicotine lozenges, gums, and patches.  So why do so many anti-tobacco organizations continuously demonize vaping while seemingly giving a free pass to the Big Pharma NRTs?

According to research published by French addiction specialist Jean-Francois Etter in collaboration with co-author Thomas Eissenberg, vaping is far less addictive than most conventional NRTs, especially nicotine-infused gums.  The research team began by monitoring the daily smoking, vaping and/or NRT usage of hundreds of participants, and the results are published on the Drug and Alcohol Dependence website.

What is the Fagerström Test?

To be clear, the two researchers conducted a survey rather than a true scientific study, but they did use certain scientific protocols to determine the levels of nicotine dependence of its participants.  Etter and Eissenberg used a process called the Fagerström Test along with another methodology named the Nicotine Dependence Syndrome Scale


The Fagerström Test is a standard evaluation technique used to assess the physical dependency of nicotine.  It consists of six basic parts that rate the compulsion to smoke, the severity of those compulsions, and the overall levels of nicotine dependence.  Answers are given numeric values, with a higher cumulative total typically signifies a greater level of nicotine dependency. 

Overview of the Etter-Eissenberg vape survey

The sole goal of the survey was to identify if vapers are more or less addicted to their vape mods and e-cigs than NRT users are to their nicotine-enhanced gums.  The control group includes the following variations of participants.

  • 766 daily users of nicotine-infused e-cigarettes
  • 30 daily users of zero-nicotine e-liquids
  • 911 former smokers who admit to vaping daily
  • 451 former smokers who admit to using nicotine-infused gum daily
  • 125 dial users of vaping technology and combustible cigarettes
  • An unidentified quantity of daily smokers who were not actively using either e-cigs or NRTs of any kind.
  • 2206 respondents enrolled for the survey online
  • 292 respondents enrolled via snail mail
  • Levels of nicotine dependence were evaluated using the Fagerström Test and the Nicotine Dependence Syndrome Scale.

Through the course of the study, Etter and Eissenberg discovered that long-term users (greater than three months) of vaping technology were significantly less addicted than users of nicotine gums.  Furthermore, the dependency ratings of both short and long-term users of nicotine gums remained relatively unchanged regarding their related levels of dependency.

Meanwhile, the vapers’ addiction to nicotine-enhanced e-liquids seemed to decline over time.  Vapers using nicotine-enhanced e-cigs were also slightly more addicted than those using zero-nicotine e-juices.  The report’s conclusions section clearly states that electronic cigarettes are far less addictive than combustible tobacco products and significantly less addictive than nicotine gums, “which themselves are not very addictive.”


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